Chronic Regional Pain Syndrome (CRPS)

Chronic Regional Pain Syndrome (CRPS) is among the most complex pain disorders that a person can face. Imagine one extremity (an arm or a leg) becoming painful for seemingly no reason. Pain leads to disuse and weakness. It becomes unbearable to wear a shirt and has increased sensitivity to even the lightest touch. Taking a shower hurts and temperatures are much hotter or colder than they once were. Gradually, there is an inability to distinguish between left and right sides, and eventually daily activities such as reaching, lifting, grabbing, standing, walking, even moving are so painful they are avoided. The doctor diagnoses a pain syndrome, but how did it happen and what can be done?

There are few risk factors that predispose a person to CRPS such as prolonged immobilization of a limb, fracture, and psychological factors such as depression and anxiety. The longer a person waits to seek treatment, the worse the deficits become and medications alone can no longer suppress the pain.

Once diagnosed, physical therapy can be an integral part of decreasing pain, regaining strength, and relearning function. Treatment of CRPS is a 5-step process that begins with educating the patient as to what is happening between the neural connectors from the brain to the affected limb. The next focus of treatment is laterality, or exercises to promote left and right discrimination. The third step is motor imagery where a patient is asked to imagine the affected extremity performing tasks or movements that are otherwise painful. This is followed by a desensitization program that introduces different textures to the hypersensitive area and works on distinguishing shapes. Finally, physical therapy uses mirror therapy whereby the unaffected extremity performs movements in front of a mirror to trick the brain into believing the tasks are being performed by the affected limb. Once these 5 components are mastered and the neural connections are restored, then traditional therapy of range of motion, strengthening and functional tasks can be implemented to ensure successful return to activities of daily living.

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